The University of Mississippi School of Pharmacy, University, Mississippi.
Baylor College of Medicine, Houston, Texas.
Arthritis Care Res (Hoboken). 2024 Oct;76(10):1427-1435. doi: 10.1002/acr.25378. Epub 2024 Jun 17.
This study compared opioid prescribing among ambulatory visits with systemic autoimmune/inflammatory rheumatic diseases (SARDs) or without and assessed factors associated with opioid prescribing in SARDs.
This cross-sectional study used the National Ambulatory Medical Care Survey between 2006 and 2019. Adult (≥18 years) visits with a primary diagnosis of SARDs, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or systemic lupus erythematosus were included in the study. Opioid prescribing was compared between those with vs without SARDs using multivariable logistic regression accounting for the complex survey design and adjusting for predisposing, enabling, and need factors within Andersen's Behavioral Model of Health Services Use. Another multivariable logistic regression examined the predictors associated with opioid prescribing in SARDs.
Annually, an average of 5.20 million (95% confidence interval [CI] 3.58-6.82) visits were made for SARDs, whereas 780.14 million (95% CI 747.56-812.72) visits were made for non-SARDs. The SARDs group was more likely to be prescribed opioids (22.53%) than the non-SARDs group (9.83%) (adjusted odds ratio [aOR] 2.65; 95% CI 1.68-4.18). Among the SARDs visits, patient age from 50 to 64 (aOR 1.95; 95% CI 1.05-3.65 relative to ages 18-49) and prescribing of glucocorticoids (aOR 1.75; 95% CI 1.20-2.54) were associated with an increased odd of opioid prescribing, whereas private insurance relative to Medicare (aOR 0.50; 95% CI 0.31-0.82) was associated with a decreased odds of opioid prescribing.
Opioid prescribing in SARDs was higher compared to non-SARDs. Concerted efforts are needed to determine the appropriateness of opioid prescribing in SARDs.
本研究比较了有和无系统性自身免疫/炎症性风湿病（SARDs）的门诊就诊患者的阿片类药物处方情况，并评估了 SARDs 患者中与阿片类药物处方相关的因素。
本横断面研究使用了 2006 年至 2019 年期间的全国门诊医疗保健调查数据。研究纳入了有 SARDs（包括类风湿关节炎、强直性脊柱炎、银屑病关节炎或系统性红斑狼疮）主要诊断的成年（≥18 岁）就诊患者。使用多变量逻辑回归比较了 SARDs 患者与非 SARDs 患者的阿片类药物处方情况，该回归考虑了复杂的调查设计，并在 Andersen 健康服务使用行为模型内调整了倾向因素、促成因素和需要因素。另一个多变量逻辑回归分析了与 SARDs 患者阿片类药物处方相关的预测因素。
平均每年有 520 万（95%置信区间 [CI] 358-682）次就诊是为了治疗 SARDs，而非 SARDs 的就诊次数为 7801.4 万（95% CI 747.56-812.72）。与非 SARDs 就诊者相比，SARDs 就诊者更有可能被开具阿片类药物处方（22.53%比 9.83%）（调整后的优势比[aOR] 2.65；95%CI 1.68-4.18）。在 SARDs 就诊中，年龄在 50-64 岁（与 18-49 岁相比，aOR 1.95；95%CI 1.05-3.65）和开具糖皮质激素（aOR 1.75；95%CI 1.20-2.54）与开具阿片类药物的几率增加相关，而与医疗保险相比，私人保险（aOR 0.50；95%CI 0.31-0.82）与开具阿片类药物的几率降低相关。
与非 SARDs 就诊者相比，SARDs 就诊者的阿片类药物处方比例更高。需要共同努力确定 SARDs 中阿片类药物处方的适当性。
